Recent Industry News

The Department of Health and Human Services (HHS) recently reported to a federal court that it will be unable to clear a backlog of Medicare billing appeals by the court-imposed deadline of 2020. Under the court’s order issued on December 5, 2016, the HHS must follow a gradual, annual backlog elimination process and file reports to the court every 90 days detbacklogailing their progress. In the first of these reports, HHS stated that the Office of Medicare Hearings and Appeals has been unable to reduce the backlog. Instead, HHS reported that there were more pending appeals than previously anticipated and that its backlog of 687,382 claims is projected to reach more than a million by the end of fiscal year 2021, rather than be eliminated. To date, HHS has only been able to slow the growth of the backlog. In December, HHS filed a motion to reconsider the decision in which it stated that the only way to reduce the backlog is if it settles the claims without actually acting upon the merits.

The case was brought before a federal district court by the American Hospital Association (AHA). The AHA alleged that it took far longer than the 90-day limit for a hospital to dispute a denied claim by Medicare Recovery Audit Contractors. As a result, the AHA claimed that HHS is not meeting the federal law mandates for the resolution of these Medicare appeals. Federal law sets forth the five-stage uniform Medicare appeals process applied to Medicare Part A and Part B reimbursement appeals. The HHS Office of Medicare Hearings and Appeals oversees the third stage of this process using their Administrative Law Judges. The Office is required to, “conduct and conclude a hearing…and render a decision on such hearing by no later than the end of the 90-day period beginning on the date a request for hearing has been timely filed.” In December, the federal court agreed with the AHA and granted their motion for summary judgment. The court ordered HHS to reduce the backlog of cases pending before administrative law judges by 30 percent by the end of 2017, 60 percent by the end of 2018, 90 percent by the end of 2019, and entirely by 2021. In January, HHS filed an appeal in this case in hopes of avoiding the 2020 deadline for clearing the backlog of appeals.